MikeRNWI

"But wearing gloves to hand someone a cup of pills or to check a BP is just crazy-pants." Try being part of an ICU study where you have to gown and glove each time you go into your patients room....

I agree with BelgianRN. You dont want to bolus your pressors. If your patient is requiring increasing doses of these medication, it is doubtful a transient dost such a as a bolus will be helpful in the long term. Once the bolus wears off, you lose its effect and have dangerous hemodynamic swings. It is much safer to simply increase the dose. My comment was implying that if you stopcock together, say, your pressors and midazolam for sedation, that if you give a bolus of midazolam, you will also give a very small bolus of vasopressor (whatever is in the catheter at that time). Sometimes you have no choice but to connect multiple drips together, but its always important to remember everything that you have connected in that line.

Yep sometimes in the ICU you need a long chain of stopcocks to manage everything. Last weekend I had a patient on with a triple lumen and a IJ dialysis catheter for CVVH. Had so much that we even had to stopcock things into the Dialysis venous return line as well. Sometimes you just have to verify what's compatible and form a chain. The only thing to be aware of in that case is if anything gets bolused, everything gets bolused for a short time...

Our code teams work similarly to the post above. Granted, we are a Level 1 Trauma center, and a academic medical center, but our ED fully handles all pre-hospital arrests themselves. Our ICU's handle their own codes (with the occassional exception of the Neuro ICU). If a Code Blue is called overhead, our ICU's rotate being code responders, and the Charge Nurses respond, along with the ICU and ED docs/pharmacists. Our hospital also has Critical Care Floats, who respond to codes(they do respond to the ED codes, but can be told to leave if adequate staff is available), help with ICU transports for scans, etc.

We do the same in my ICU. We use a coolguard femoral or subclavian line, which has 5 lumens, 3 for infusion of medications, and two closed circuit lumens that circulate water. Cool as quickly as possible to get down to 31-32 degree C. Once at goal temperature, keep cooled for roughly 24 hours. When beginning to rewarm, we shoot for .5 degrees C an hour. The coolguard machine can actually control the speed of rewarming, it has to be connected to a core temperature source. As mentioned before, the most important part is watching for ectopy and electrolyte imbalances.

Ill second the amazing camaraderie and teamwork. So many nurses who transfer from the floor to our ICU are amazed at the amount of help we do for each other, on the floor it was just everyone does their own thing. In my ICU, when we get an admission, at least 3-4 nurses and an NA are in the room, settling the patient, drawing labs, hooking up to monitors, etc. The entire admission usually takes like 10 minutes unless its a real sickie!!! I also love the fact after a long weekend (or just a rough day/night) often our nurses will go out for a drink and some food just as an opportunity to unwind! (Heck, we even have had attending docs come out with us!!!) It may not sound like much, but I truly believe that it helps build that sense of teamwork and togetherness that everyone can be social outside of work in addition to being professional inside

If you want to get some good information (especially patho stuff) on critical care, look into some of the CCRN study books. CCRN is the Certification for Critical Care Nurses. Depending on your learning style, there are a bunch of good books. I'm studying for my CCRN right now, and I am using PassCCRN since it has a nice outline format as well as a CD of questions. Much of specific things such as "effectively" running CRRT (can be quite a tricky thing to learn even when you know what you are doing) and titrating drips is something that is best learned hands on, but having the background knowledge of how things work is vitally important to understand! It is great to want to learn as much as possible when you are dealing with such sick patients! Another source would be The ICU Book by Paul Marino, it is geared towards docs so it may be above what you are currently looking for but it has a lot of pretty good info related to pathophys and pharm stuff as well as various diseases and their treatments seen in the ICU.

I will also say, in the ICU patients, there is absolutely nothing sexy or sexual about anything that you see there, but you do deal with the genitals quite often. Incontinent patients, swollen genitals, catheters and "tube feed stool" just to name a few. The patients are critically ill and you learn that modesty quickly goes out the window, talking about things quickly becomes second nature. Its just a learned trait, but it is part of the reason why all the different clinicals are necessary.

What??????

At my hospital, step down units usually take patients who have spent time in the ICU, and are mostly better, but still need a bit closer attention/management then general care floor. Usually, staffing ratios are better then the floor (I think 3:1 in IMC, with 2:1 in ICU) Our IMC takes stable, trached, vented patients, a few vasoactive drips (Mostly nitro I think). We help train our IMC nurses by having them spend some time in the ICU so they know what they will be dealing with. A few experiences with sickies, vents and drips, and then try to get them stable patients so they can experience it while still having an ICU nurse as a back-up.

http://www.icufaqs.org/ Check out the section for Peripheral IV's for beginners. And yes, its practice practice practice.

Even with central lines, a ml or two of air is not something to be concerned with. In fact, there is a study done with echocardiograms called a "Bubble Study", in which 1 mL of air is agitated within 9 mL of saline (Use a full syringe and and empty one with a stop cock, and push the saline/air back and forth until it gets frothy) than you inject that into the patient. This helps to show you the pathway that the blood is taking through the heart, and therefore any abnormalities therein, such as a R to L shunt. However, that being said, always attempt to remove the bubble from the syringe by pointing it straight up and squirting the air until saline comes out. Then, flush away!

So, Onradar, since you know so much, you surely know where the OP lives, and that there is a bus route right past their house, directly (or with few stops) to their place of employment. No one ever lives anywhere that is not on a bus route, or in a town that does not have strong public transportation, ever. People dont live outside of cities, where there is no such this as a bus, let alone a 5 dollar bus ride.... As xtxrn said.... dude...

So... I had to reread. I first saw this say head and heart transplants.... I was really intrigued and perplexed with the concept of head transplants....

To the OP, I to just got my TB test done, and I also had a red, swollen looking circle. This is a pretty typical reaction for me, and I have been told that I have an allergic reaction to the preservative in the injection. Maybe this is the same with you? I dont have allergies to anything else really, but I always react in the same way to my TB tests...